Modifying Effects of Resting Heart Rate on the Association of Binge Drinking With All-cause and Cardiovascular Mortality in Older Korean Men: the Kangwha Cohort Study

Background

Although binge drinking and high resting heart rate independently affect cardiovascular and all-cause mortality risk, the combined effect of these two risk factors and their interaction has rarely been studied. This study examined the association between binge drinking and cardiovascular and all-cause mortality and evaluated the potential modifying effect on this association of resting heart rate in Korean men.

Methods

Men aged 55 years or older in 1985 (n = 2600) were followed for cardiovascular and all-cause mortality for 20.8 years, until 2005. We estimated hazard ratios (HRs) for cardiovascular and all-cause mortality by binge drinking and resting heart rate using the Cox proportional hazard model.

Results

Heavy binge drinkers (≥12 drinks on one occasion) with elevated resting heart rate (≥80 bpm) had a HR of 2.25 (95% confidence interval [CI], 1.47–3.45) for death from cardiovascular disease and 1.37 (95% CI, 0.87–2.14) for all-cause mortality compared to the reference group (non-drinking and resting heart rate 61–79 bpm). The HRs of dying from cardiovascular disease increased linearly from 1.36 to 1.52, 1.71, and 2.25 among individuals with resting heart rate greater than or equal to 80 bpm within the four alcohol consumption categories (non-drinking, non-binge, moderate binge, and heavy binge), respectively.

Conclusions

Our findings suggest that, among older Korean men, heavy binge drinkers with an elevated resting heart rate are at high risk for cardiovascular and all-cause mortality.Key words: alcohol drinking, binge drinking, cardiovascular disease, mortality, resting heart rate     

Kawasaki disease in Mongolia: results from 2 nationwide retrospective surveys, 1996-2008

Background

Kawasaki disease (KD) has been reported in many countries. However, the incidence of KD in Mongolia is not known. This is the first report of incident cases of KD in Mongolia, which were identified using data from 2 nationwide surveys.

Methods

Two nationwide retrospective surveys were conducted: medical histories were collected from patients aged 0 to 16 years who were hospitalized countrywide between 1996 and 2008. Hospital records for these patients were also reviewed. Nationwide training seminars on KD were conducted before each survey.

Results

For the nationwide surveys, the participation rates among all hospitals with pediatric wards were 97% and 94%. Inpatient medical histories from 1996 through 2008 were reviewed, and, among children younger than 16 years, 9 patients with KD were investigated. The age of KD patients ranged from 1.4 to 14 years; 7 of 9 patients were male. Six (67%) patients fulfilled all 6 clinical diagnostic criteria; the other 3 (33%) were defined as having KD based on the presence of 5 such criteria. Fever persisting 5 or more days, bilateral conjunctival congestion, and changes of the lips and oral cavity were the most common symptoms, and cervical lymphadenopathy was the least common symptom. Cardiac sequelae developed in 5 of the patients, 4 of whom were older than 10 years.

Conclusions

The results of these nationwide surveys reveal that KD cases do exist in Mongolia. However, knowledge of KD among Mongolian pediatricians is likely to be poor. Thus, there is a need to augment their understanding to improve management of KD patients. Further studies are crucial to clarify the epidemiologic characteristics of KD in Mongolia.Key words: mucocutaneous lymph node syndrome, nationwide survey, Mongolia, children     

Male infertility： risk factors in Mongolian men

Aim: To determine the most common risk factors of male infertility in Mongolian men attending an infertility clinic. Methods: A prospective, case-control study was conducted in which 430 men were enrolled. All the men had sought their first infertility evaluation between 1998-2002 in the State Research Center on Maternal Child Health, Ulaanbaatar, Mongolia. They were divided into two groups depending on the results of their semen analysis:191 with abnormal semen and 239 with normal semen profile. Univariate and multivariate analyses were performed to determine any association between risk factors and semen abnormality. Results: Logistic regression analysis demonstrated that the testicular volume, a history of sexually transmitted infections (STI), epididymitis and testicular damage all have statistically significant associations with semen abnormality, when controlled for multiple risk factors.Adjusted odds ratios of 3.4 for mumps orchitis, 2.3 for other orchitis and 3.9 for testicular injury were found.Gonorrhoea, the most commonly reported STIs in this study, gave an adjusted odds ratio of 1.0 for having one or more sperm abnormality. An adjusted odds ratio for subjects with a history of other STIs was 2.7. However, as a predictor of azoospermia, STIs had very high odds ratio, being 5.6 in patients with gonorrhoea and 7.6 in patients with other STIs. Conclusion: A history of pathology involving testicular damage appeared to have the strongest impact on male infertility in Mongolia. STIs have less impact on semen quality except when complicated by orchitis, epididymitis and vasal obstruction. (Asian J Androl 2004 Dec, 6: 305-311)     

Clinical patterns and major causes of infertility in Mongolia

OBJECTIVE: To determine the clinical patterns and major causes of infertility in Mongolia, based on the clinical and laboratory findings of both partners, and to compare the findings with data from the published World Health Organization (WHO) multicenter study. METHODS: Four hundred and thirty infertile couples who attended the Infertility Clinic of the State Research Center on Maternal Child Health in 1998-2002 were included in the study. The couples had not had a viable birth after at least 1 year of unprotected intercourse and agreed to be fully investigated according to the WHO protocol 'Standardized Investigation of the Infertile Couple'. RESULTS: The mean duration of infertility of couples was 4.9 +/- 0.2 years. 43.7% of women had secondary infertility. In the females, the prevalence of past history of sexually transmitted infection (STI) and pelvic inflammatory disease were 33.5% and 25.1%, respectively. In the male partner, 44.2% reported a history of STI and 27.7% had previous testicular damage. 32.8% of women had a tubal factor. The most common causes of male infertility were obstructive azoospermia (8.4%), male accessory gland infection (6.7%) and acquired testicular damage (5.4%). In 45.8% of couples, infertility was due to a female factor and in 25.6% of cases, infertility was due to a male factor. 9.8% of couples had no demonstrable cause in either partner and 18.8% of couples had an infertility diagnosis in both partners. CONCLUSION: Patterns of female infertility did not differ significantly from those in the WHO study. Male infertility had a unique pattern, as there was a high prevalence of obstructive azoospermia and previous testicular damage.     

Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort Study

OBJECTIVE: The purpose of this study was to examine the relation between age at natural menopause and all-cause and cause-specific mortality among women. METHODS: This study used the data of the Kangwha Cohort that was followed up from 1985 to 2001, in particular, for the group of 55 years or older women (n=2658). We calculated the hazard ratio of mortality by the group of age at menopause using the Cox proportional hazards model with adjustment for age, alcohol consumption, education, age at first birth, self-cognitive health level, chronic disease, marital partner, parity, age at menarche, oral contraceptive use and hypertension. RESULTS: The mean (standard deviation) age at menopause was 46.9 (4.9) years, and the median age was 48 years. After adjusting for the relevant variables, the risk of total death in the early menopause group (<40 years at menopause) was 1.32 times higher than that of the reference group (45-49 years at menopause) (95% confidence interval [CI], 1.05-1.66, p=0.02). For the early menopause group, relative to the reference group, the adjusted hazard ratios of death due to cardiovascular disease and cancer were 1.53 (95% CI, 1.00-2.39, p=0.04) and 2.01 (95% CI, 1.06-3.82, p=0.03), respectively. CONCLUSION: Through this study, the age at menopause was found to be different between Asian and Caucasian women and the association of age at menopause with death, particularly caused by cardiovascular disease and cancer, was validated. Our study is one of rare studies regarding the age at menopause of Asian women and their risk of mortality, which could be considered to be meaningful.     

Gender-specific combined effects of smoking and hypertension on cardiovascular disease mortality in elderly Koreans: The Kangwha Cohort Study

Objective

We examined gender-specific combined effects of smoking and hypertension on risk of mortality from cardiovascular disease in elderly Korean men and women.

Study design

This study followed a cohort of 6097 residents (2593 men, 3504 women) in the general population of Kangwha County, aged ≥55 years in March 1985 and examined their cause-specific mortality for 20.8 years, up to December 31, 2005. All participants were followed up more than once after the 1985 survey.

Main outcome measures

We calculated hazard ratios for mortality for the combined sets of smoking habits and blood pressure levels using the Cox proportional-hazard model. The set of non-smokers with normal blood pressure served as a reference group.

Results

During the 20.8 years of follow-up, 759 people died from cardiovascular disease. The risk of mortality from cardiovascular disease and stroke according to smoking or hypertension was not different between men and women. However, the risk among smokers combined with hypertension was higher in men than in women; the multivariable-adjusted hazard ratios (95% CI) for mortality from cardiovascular disease and stroke were 4.52 (1.67–12.21) and 6.37 (1.57–25.85) in men and 2.11 (1.37–3.24) and 2.41 (1.44–4.01) in women, respectively.

Conclusions

The magnitude of the joint effects of smoking and hypertension on cardiovascular disease and stroke mortality was different between men and women. This study suggests that combining quitting smoking with lowering blood pressure could contribute to preventing cardiovascular disease and stroke, especially in men.     

A comparison of perinatal mortality in Korea on holidays and working days

OBJECTIVE: To examine whether the perinatal mortality of infants born during holidays differs from that of infants born on workdays, and to elucidate its cause. DESIGN: Cross-sectional study. Setting Vital statistics linked to the National Infant Mortality Survey data for 1999 births in Korea. POPULATION: In all, 628 485 births in 1999 in Korea. METHODS: Number of births and perinatal mortality were classified according to the day of the week using the occurrence index. After adjusting for confounding factors, the odds ratios (ORs) for increased holiday mortality were estimated using logistic regression. MAIN OUTCOME MEASURE: Birthweight-adjusted perinatal mortality. RESULTS: Births on holidays were 33% fewer and perinatal deaths 24% higher than expected (PMR, Perinatal Mortality Rate, 16.4 versus 12.8; OR, 1.3; 95% CI, 1.2-1.4). After the adjustment of birthweight, gender, plurality and congenital anomalies, the odds ratio for death of infants born during holidays was 1.2 (95% CI, 1.1-1.3). CONCLUSIONS: The higher perinatal mortality during holidays in Korea appears to be due to different qualities of perinatal care, rather than difference in case-mix.